Fact Checker: Anti-health-care ad makes claim that doesn't add up

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By Glenn KesslerThe Washington Post

Rockford Register Star

By Glenn KesslerThe Washington Post

Posted Feb. 21, 2014 at 10:00 AM

By Glenn KesslerThe Washington Post

Posted Feb. 21, 2014 at 10:00 AM

"I was diagnosed with leukemia. I found out I only have a 20 percent chance of surviving. I found this wonderful doctor and a great health care plan. I was doing fairly well fighting the cancer, fighting the leukemia, and then I received a letter. My insurance was canceled because of 'Obamacare.' Now, the out-of-pocket costs are so high, it's unaffordable. If I do not receive my medication, I will die. I believed the president. I believed I could keep my health insurance plan. I feel lied to. It's heartbreaking for me. Congressman Peters, your decision to vote Obamacare jeopardized my health."

- Michigan resident Julia Boonstra, in a new ad sponsored by Americans for Prosperity (AFP), attacking Rep. Gary Peters, D-Mich., a candidate for the Senate

This emotional and gut-wrenching attack ad should be every Democrat's worst nightmare, combining references to President Barack Obama's false promise with a raw account of a woman who says she suffered because of the Affordable Care Act, aka Obamacare.

But do the facts match the emotions?

The Facts

First of all, many viewers might think Boonstra lost her doctor, as she mentions her "wonderful doctor" and then says her plan was canceled. But AFP confirms that she was able to find a plan, via Blue Cross Blue Shield, that had her doctor in its network.

Local news reports recount that Boonstra, like many Americans, initially had trouble getting a plan because of the botched launch of Healthcare.gov. No doubt that was a difficult experience. She then was invited by her local member of Congress to attend the State of the Union address and participated in a Republican National Committee news conference that highlighted problems with the health-care exchange's stumbling launch.

At that news conference, Boonstra said, "I'm paying a higher cost now as far as out-of- pocket costs and the coverage is just not the same." But in the new ad she says "the out-of-pocket costs are so high, it's unaffordable."

The claim that the costs are now "unaffordable" appeared odd because, under the ACA, there is an out-of-pocket maximum of $6,350 for an individual plan, after which the insurance plan pays 100 percent of covered benefits. The Blue Cross Blue Shield plans in Michigan that appear to match Boonstra's plan, as described in local news reports, all have that limit.

Meanwhile, Boonstra told the Detroit News that her monthly premiums were cut in half, from $1,100 a month to $571. That's a savings of $529 a month. Over the course of a year, the premium savings amounts to $6,348 - just two dollars shy of the out-of-pocket maximum.

We were unable to reach Boonstra, but on the face of it, the premium savings appear to match whatever out-of-pocket costs she now faces.

Page 2 of 2 - Levi Russell, a spokesman for AFP, said he "would assume there is an OOP [out-of-pocket] max, but this is the story of Julie, a real person suffering from blood cancer, not some neat and tidy White House PowerPoint about how the ACA is helping everyone." He said there is a possibility that her specific chemotherapy medication will not be covered.

"Julie's concerns about her new plan are ongoing and very personal. Since her out-of- pocket costs are so much higher now, her costs have quickly become unpredictable," he added. "Rather than knowing exactly what she would have to pay every month, she now is facing a roller coaster of expenses that vary with her health. She said she feels like a surprise is around every corner, since she keeps being hit with new out-of-pocket costs every time she needs treatment, or a test, or even an office visit."

He concluded: "Now her expenses are unpredictable, and that means unaffordable. It could be $600 one month, and three times that the next month. The reality of what she's dealing with is much more involved and can't be swept aside by saying, 'you have an OOP maximum so quit complaining about your cancer.' "

The Fact Checker surely does not want to play down the emotional anguish that any cancer patient may face, but a fuller accounting is necessary if AFP is going to air ads like this. In order to properly compare the old plan and the new plan, there needs to be fuller disclosure of the costs and out-of-pocket maximums before claims that the new plan is "unaffordable" can be accepted at face value. Too many anecdotal stories, on both sides, have fallen apart under close scrutiny.

Russell passed along a quote from Boonstra: "My plan, the premiums are half, but the out-of-pocket costs are so high that for me, it's unaffordable. My coverage is 80/20. Blood work, I'm paying 20 percent. If I needed a bone marrow transplant, I would only be covered 80 percent. Everything, everything I do now, I have to pay a percentage of."

It is one thing to say there are higher out-of-pocket costs, as she did at the RNC news conference, but another to assume that those higher costs are not offset in some way by the significantly lower premium. The reality is that eventually Boonstra will hit the maximum and no longer pay anything. So over the course of the year, the difference in the costs could well even out.